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Biomedical subjects

E Moss

Publications and source records attributed to E Moss.

At least 37 records · Page 2Linked to original sources
PubMed1996

The reinforced laryngeal mask airway for dento-alveolar surgery.

We have evaluated the reinforced laryngeal mask airway (LMA) for use during dento-alveolar surgery in 100 ASA I and II day-case patients allocated randomly to receive either a nasotracheal tube or reinforced LMA. We recorded ease of airway insertion, airway complications, quality of recovery and replies to a 24-h postoperative questionnaire. In addition, a fibreoptic assessment was made of laryngotracheal soiling, and the effect of head movement and the position of the reinforced LMA. There were no significant differences in difficulty in airway positioning or perioperative oxygen desaturation. Nineteen patients in the nasotracheal tube group had epistaxis (P = 0.001) and laryngotracheal soiling occurred in three of these patients. Two reinforced LMA were dislodged on moving into the operating theatre and in a further five patients in this group there was partial airway obstruction (compared with none in the nasotracheal tube group; P = 0.018) which was caused by downward pressure on the mandible by the surgeon. There were no differences in postoperative complications. No surgeon reported poor access to the operating field. Overall the reinforced LMA provided satisfactory conditions for this surgery but vigilance of the airway was required, especially at the time of extraction.

Adolescent↗
PubMed1996

Long-term outcome in infants with the shaking-impact syndrome.

Nonaccidental injury accounts for nearly one quarter of all hospital admissions for head injury in infancy, and is associated with significant morbidity and mortality. Long-term outcome in survivors, however, has been incompletely studied. In this series, 84 infants 2 years of age and younger with the shaking-impact syndrome consecutively admitted to a single hospital between 1978 and 1988 were identified. A questionnaire detailing current medical, developmental, and behavioral status was developed, and attempts were made to locate the 62 children surviving the acute injury. Family instability and strict confidentiality restrictions precluded locating the majority of children, but 14 children with demographic and injury characteristics similar to those of the overall group were contacted at an average of 9 years after injury. Seven children were severely disabled or vegetative, 2 were moderately disabled, and 5 had a good outcome. Of the latter group, 3 had repeated grades and/or required tutoring. Acute factors associated with poor outcome included unresponsiveness on admission, need for intubation, age less than 6 months, and bilateral or unilateral diffuse hypodensity on CT scan. All children with bilateral diffuse hypodensity and loss of gray-white differentiation on CT scan remained blind, retarded, nonverbal, and nonambulatory in spite of aggressive medical and surgical management. This study suggests that the majority of children surviving the shaking-impact syndrome suffer major permanent morbidity, and that acute factors predicting long-term outcome may help guide aggressiveness of care.

Adolescent↗
PubMed1995

Group supervision: focus on countertransference.

This paper examines the advantages of a particular way of supervising psychotherapy, namely, in a group setting with a special focus on the supervisee's countertransference experience. Group supervision is conceptualized as much more than presenting a case and getting feedback. Rather, the group is used in all its interactive complexity as it resonates in a myriad of ways to aspects of the case being presented. Furthermore, because of the complexity of conscious and unconscious interactions and reverberations during this process, it is often helpful to have a focus in the supervision. One helpful possibility is to center on the supervisee's countertransference experience and use the group to reflect, amplify, and process that experience. This can be a highly valuable way of helping the therapists increase their understanding of the case and enhance the quality of therapeutic interventions.

Countertransference↗
PubMed1995

Effects of changes in mean arterial pressure on SjO2 during cerebral aneurysm surgery.

Twenty-six patients requiring clipping of cerebral aneurysms were anaesthetized with propofol, alfentanil and atracurium infusions and their lungs ventilated mechanically to hypocapnia (3.4-4.5 kPa). SjO2 was measured continuously with an Oximetrix fibreoptic oximetry catheter. Normovolaemia was maintained by observing the response of mean arterial pressure (MAP) and central venous pressure (CVP) to fluid administration. The response of SjO2 to increased MAP was noted and the lactate oxygen index (LOI) calculated at regular intervals. SjO2 measurements indicated a critical MAP of between 80 and 110 mm Hg in nine patients, and one patient had a persistently low SjO2 value despite an MAP of 110 mm Hg. An increase in MAP was associated with an increase in SjO2 in 19 patients (P < 0.001). When the effects of changes in PaCO2 were eliminated, this change was still significant (P = 0.004) (n = 9). Patients with an LOI > 0.08 at any time during the procedure had a worse initial outcome (within the first day) (P < 0.02) than patients who had a normal LOI throughout. Long-term outcome was similar to those with a normal LOI. Increasing MAP did not have a consistent effect on LOI. Jugular bulb cannulation to assess hypoperfusion in conjunction with lactate measurements and calculation of LOI provide useful information on which to base the intra- and postoperative management of patients with subarachnoid haemorrhage.

Blood Pressure↗
PubMed1995

Treating the love-sick patient.

Love-sick patients come to therapy because they are suffering from an obsession. Their lover has left, apparently for good. They cannot accept this fact, mourn the loss and get on with life. Object relations theory offers a framework for better understanding their suffering. The patients described have experienced early relationship disturbances, and their adult love offered an illusory defence against deep feelings of fragility and low self-esteem. Accepting the finality of their lover's departure meant re-experiencing feelings of abandonment and worthlessness. An effective psychodynamic strategy in cases like these is to focus on these painful feelings, particularly as they appear in the therapy relationship. Learning to tolerate them in this relationship can be a positive step towards accepting the lover's departure.

Adult↗
PubMed1994

Air in the cavernous sinus following scalp vein cannulation.

A 7-month-old infant was found to have air in the cavernous sinus during a CT scan under general anaesthesia. An anterior scalp vein had been used to administer atracurium and contrast. The anatomy and precautions to prevent air embolism during scalp vein cannulation are discussed.

Catheterization, Peripheral↗
PubMed1993

Comparison of propofol with enflurane during hypotensive anaesthesia for middle ear surgery.

Forty patients undergoing middle ear surgery were allocated randomly to receive propofol induction and maintenance, or thiopentone induction and enflurane maintenance for anaesthesia. Both groups also received fentanyl, alcuronium, nitrous oxide and oxygen. If this did not reduce systolic arterial pressure to 70 mm Hg, labetalol, glyceryl trinitrate (GTN), or both, was administered. Fifteen control patients had enflurane anaesthesia without hypotension. Pre- and postoperative psychometric tests were performed in all groups. The propofol group received significantly more labetalol (P = 0.014) and GTN (P = 0.004) than the enflurane group. There was a greater increase in reaction times after operation in the study groups (P < 0.05) compared with controls. There was no difference between the propofol and enflurane groups in control of arterial pressure, recovery from anaesthesia or psychometric testing.

Adolescent↗
PubMed1993

A comparison of the effect of isoflurane and propofol on arterial carbon dioxide tensions following intracranial surgery.

Thirty-four adult patients undergoing elective craniotomy were randomly allocated to receive either isoflurane or propofol to supplement nitrous oxide and fentanyl for maintenance of anaesthesia. Arterial blood gases were measured pre-operatively before premedication and at 5, 15, 30 and 60 min after tracheal extubation. The arterial carbon dioxide tension was higher than the preoperative value 5 min after tracheal extubation in both groups (p < 0.01), but there was no difference between the two groups at any time. It is concluded that the degree of postoperative respiratory depression after intracranial surgery is short-lived and minimal following maintenance of anaesthesia with either propofol or isoflurane.

Anesthesia, General↗
PubMed1992

Assessment of rejection in orthotopic human heart transplantation using proliferating cell nuclear antigen (PCNA) as an index of cell proliferation.

Myocardial biopsies taken during the management of cardiac transplantation were stained for proliferating cell nuclear antigen (PCNA). Counts of PCNA-positive interstitial cells were compared, in retrospect, with the reported histological grade of rejection. Biopsies without rejection had negligible numbers of PCNA-positive cells. Ascending grades of rejection were paralleled by an increase in the number of PCNA-positive cells [grade 1, 13 +/- 35 (mean +/- SD); grade 2a, 38 +/- 40; grade 2b, 91 +/- 75; grade 3, 170 +/- 78]. While highly significant, in statistical terms, the overlap in the counts between different grades means that prediction of rejection from the PCNA count alone is not feasible. Biopsies graded as 0 or 1 and which immediately preceded more severe rejection episodes showed no increase in PCNA-positive cells. The majority of PCNA-positive cells are fibroblasts, although in grade 2b and 3 rejection a small population of PCNA-positive T lymphocytes occurs. PCNA staining is also seen in cardiac myocytes immediately after transplantation, during rejection episodes, and late after transplantation in the absence of rejection. The positive PCNA staining of cardiac myocytes probably reflects DNA synthesis that occurs with the shift toward polyploidy in hypertrophy.

Autoantigens↗
PubMed1992

Alfentanil increases intracranial pressure when intracranial compliance is low.

Intracranial pressure increases following the administration of alfentanil 1 mg are reported in five patients with suspected normal pressure hydrocephalus who were undergoing infusion of saline into a lateral ventricle to measure cerebrospinal fluid outflow resistance. The increase in intracranial pressure was accompanied by a fall in mean arterial pressure. These observations show that, when the intracranial compliance is reduced, alfentanil can cause considerable increases in intracranial pressure and decreases in cerebral perfusion pressure.

Aged↗
PubMed1992

Atrial myxoma: a tumour in search of its origins.

OBJECTIVE: To determine whether atrial myxomas express antigens suggesting a neural origin. DESIGN: A retrospective analysis based on immunohistochemical examination of myxoma tissue. SETTING: Atrial myxomas excised by two tertiary referral cardiothoracic surgical units. SUBJECTS: 24 excised atrial myxomas. Three were from known cases of familial myxoma syndrome. METHODS: Immunohistochemical identifications of three neuroendocrine markers (protein gene product (PGP) 9.5, neurone specific enolase (NSE), synaptophysin) and S100 antigen; CD34 and von Willebrand factor; and chi smooth muscle actin to identify possible Schwann cell differentiation, endothelial cells, and smooth muscle cells respectively. RESULTS: The myxoma cells were PGP 9.5 positive in 18, S100 positive in 16, and NSE positive in 12. Of the 12 NSE positive myxomas seven were synaptophysin positive. All tumours that were NSE positive were also S100 and PGP 9.5 positive. The tumour surface was partially covered by myxoma cells, partly by endothelial cells. CONCLUSION: The histological appearances of myxomas with stellate cells embedded within a loose connective tissue stroma, abundant basophil cell infiltration, and the presence of pericellular type IV collagen are similar to nerve sheath tumours (neurofibromas) at other sites. A significant proportion of myxomas also express Schwann cell and neuroendocrine differentiation markers. These features cannot prove the origin of myxomas because tumours may develop aberrant phenotype expression but they do accord with the view that myxomas originate from endocardial sensory nerve tissue.

Antigens, Neoplasm↗
PubMed1991

Nuclear DNA profiles in primary melanomas and their metastases.

DNA-aneuploid primary melanomas are said to show a greater propensity to metastasize than those without an aneuploid profile. A higher aneuploid rate has also been reported in metastatic melanomas than in primary lesions. The ploidy profile was determined of 26 primary melanomas and their first subsequent secondaries on Feulgen-stained sections from routinely processed material using a computerized video image-analysis system. In 18 of 26 cases, both primary and secondary tumor showed similar corresponding DNA patterns. These were aneuploid in 13 of 18 of the cases. A hyperdiploid pattern was present in one case in both the primary and its metastasis, and a diploid pattern was seen in four cases. There were only eight cases in which a disparity between the nuclear ploidy profile in the primary and secondary tumor was evident. Although the results suggest that ploidy studies are not useful for predicting the metastatic potential of a primary melanoma, the maintenance of similar DNA profiles in the metastases in most of these cases was interesting in regard to tumor biology.

Aneuploidy↗
PubMed1991

Laryngeal paragangliomas and neuroendocrine carcinomas.

Forty-eight neuroendocrine tumours of the larynx were studied, of which 41 were classified as large cell neuroendocrine carcinoma. Most of these tumours occurred in the supraglottic larynx and the patients were predominantly male. Exquisite pain was a presenting feature in one third. These carcinomas metastasized, frequently to skin, giving rise to painful secondary lesions, but long-time survival occurred. Histologically, large cell neuroendocrine carcinoma had a number of features seen in neuroendocrine tumours at other sites, including grouping into 'Zellballen' which mimics paraganglioma. Four tumours were definite paragangliomas. These tumours have behaved benignly. There were three cases of small cell neuroendocrine carcinoma, a tumour which is histologically identical to its counterpart in the bronchus and has a very aggressive course. All three types of tumour expressed general neuroendocrine markers, but only large cell neuroendocrine carcinoma marked for both cytokeratin and calcitonin. In the paraganglioma cases sustentacular cells were identified and marked for S-100 protein and glial fibrillary acidic protein. Histological examination, supplemented with immunohistochemistry, helped distinguish these tumours into those requiring different treatment regimens.

Adolescent↗
PubMed1991

Nuclear ploidy in neuroendocrine neoplasms of the larynx.

Seventeen neuroendocrine neoplasms of the larynx were examined for DNA ploidy. Twelve tumours were atypical carcinoids, four paragangliomas and one a small cell neuroendocrine carcinoma. Seven atypical carcinoids were aneuploid, one diploid and one tetraploid, with metastasis being aneuploid. In three cases only skin metastases were available for study, which were aneuploid. The small cell neuroendocrine carcinoma was aneuploid. Two of the paragangliomas were aneuploid and two diploid. Like other sites, neuroendocrine neoplasms of the larynx have a high rate of aneuploidy. Determination of DNA ploidy did not provide useful diagnostic or prognostic information.

Aged↗